Provider Demographics
NPI:1659850683
Name:KEARNS, GLENAJEAN W (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GLENAJEAN
Middle Name:W
Last Name:KEARNS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1343
Mailing Address - Country:US
Mailing Address - Phone:601-942-3898
Mailing Address - Fax:
Practice Address - Street 1:1625 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1343
Practice Address - Country:US
Practice Address - Phone:601-942-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist